- A new replication study found no evidence of an association between current vape use and chronic kidney disease in U.S. adults.
- Results contrast with an earlier analysis that reported higher kidney disease risk among people who vape.
- Differences appear driven by methodological flaws in the earlier study, including failure to separate smokers, former smokers, and never smokers.
- Researchers say the findings highlight the importance of rigorous study design when assessing health risks of nicotine products.
A large U.S. replication study has found no evidence that using vapes is associated with chronic kidney disease, challenging earlier claims that vaping increases the risk of kidney problems.
The study, published in the Open Journal of Nephrology, re-examined data from the National Health and Nutrition Examination Survey (NHANES) covering the years 2017 to 2020.
Using a more detailed and methodologically rigorous approach, researchers were unable to reproduce findings from a 2025 analysis that linked vape use to significantly higher odds of chronic kidney disease.
“Results showed no evidence of an association between current EC (electronic cigarette) use and CKD (chronic kidney disease) prevalence or risk progression across all segments and definitions,” the authors wrote.
Revisiting a controversial finding
Chronic kidney disease affects more than 35 million adults in the U.S. and is strongly associated with age, diabetes, hypertension, obesity, and smoking. While the risks of combustible cigarettes are well established, the health effects of vapes remain an active area of research.
In 2025, a widely cited cross-sectional study using NHANES data reported that people who used vapes had 2.5-fold higher odds of chronic kidney disease, with risk increasing alongside vaping frequency.
The new study was launched after researchers identified what they described as “methodological concerns” in the earlier analysis. These included failure to properly account for cigarette smoking history and reliance on statistical models with very few kidney disease cases among people who vaped.
A more detailed analysis
To address those issues, the authors analysed the complete pre-pandemic NHANES 2017–2020 dataset, which included more than 8,000 adults. Participants were carefully grouped into current smokers, former smokers, and never smokers, reducing the risk that smoking-related harms could be misattributed to vaping.
Vape use was defined as use in the past five days, the only measure available across all survey cycles. Kidney health was measured using the same ‘yes-or-no’ criteria as the earlier study, as well as an internationally recognised kidney disease risk scale.
Using several different types of analysis, the researchers found no statistically significant link between vaping and kidney disease.
Among people who had never smoked cigarettes, there was only a single case of chronic kidney disease identified among vape users, limiting the ability to draw risk estimates. Among current and former smokers, kidney disease rates were similar or lower among those who used vapes once age and health differences were taken into account.
Explaining the earlier result
The study suggests that the earlier finding linking vaping to kidney disease was likely driven by differences in age and health status rather than vaping itself.
“Unadjusted lower CKD rates in EC users were driven by younger age and lower comorbidity burden,” the authors wrote. They also found that frequent vape use was most common among people who had recently stopped smoking cigarettes, a group already at elevated risk for smoking-related disease.
According to the authors, failing to separate current smokers from former and never smokers can create misleading associations, especially when studying chronic conditions that develop over many years.
“This study underscores the critical importance of precise exposure characterization and segmentation in tobacco-related observational research to avoid misattribution of CC-related risks to ECs,” the paper states.
Limitations remain
The researchers emphasised that their findings do not prove vapes are risk-free. Like most NHANES analyses, the study was cross-sectional, meaning it captured a single moment in time rather than tracking health outcomes over years.
The authors also noted limitations in available data, including the absence of long-term vaping history and the small number of kidney disease cases among people who used vapes.
“Without these data, it is impossible to determine which came first, the harm event, or the start of EC use,” they wrote.
Alarming and unreliable headlines
For now, the findings suggest that claims linking vaping directly to chronic kidney disease should be treated with caution. The authors argue that future research will require more detailed tracking of vaping duration and smoking cessation history to draw firmer conclusions.
Within the limits of the data available, however, the replication study found no evidence that vaping itself is associated with chronic kidney disease in U.S. adults – and highlighted how easily poor study design can lead to alarming but unreliable headlines.
